The classification and common modifications and examples used to assist in patient classification are shown. Modifications and examples have been widely published by a variety of organizations over the years but modifications were not adopted by the ASA until 2014.
Studies of inter-rater reliability in both the adult and pediatric literature show a high degree of variability (high inter-observer inconsistency), which has limited the validity and usefulness of the classification for clinical and regulatory purposes.
See PubMed literature search describing inter-observer variability. See Wikipedia: ASA physical status classification system
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American Society of Anesthesiologists
ASA PHYSICAL STATUS CLASSIFICATION SYSTEM
Last approved by the ASA House of Delegates on October 15, 2014
Current definitions (NO CHANGE) and Examples (NEW)
| ASA PS Classification |
Definition |
Examples, including, but not limited to: |
| ASA I |
A normal healthy patient |
Healthy, non-smoking, no or minimal alcohol use |
| ASA II |
A patient with mild systemic disease |
Mild diseases only without substantive functional limitations. Examples include (but not limited to): current smoker, social alcohol drinker, pregnancy, obesity (30 < BMI < 40), well-controlled DM/HTN, mild lung disease |
| ASA III |
A patient with severe systemic disease |
Substantive functional limitations; One or more moderate to severe diseases. Examples include (but not limited to): poorly controlled DM or HTN, COPD, morbid obesity (BMI ≥40), active hepatitis, alcohol dependence or abuse, implanted pacemaker, moderate reduction of ejection fraction, ESRD undergoing regularly scheduled dialysis, premature infant PCA < 60 weeks, history (>3 months) of MI, CVA, TIA, or CAD/stents. |
| ASA IV |
A patient with severe systemic disease that is a constant threat to life |
Examples include (but not limited to): recent ( < 3 months) MI, CVA, TIA, or CAD/stents, ongoing cardiac ischemia or severe valve dysfunction, severe reduction of ejection fraction, sepsis, DIC, ARD or ESRD not undergoing regularly scheduled dialysis |
| ASA V |
A moribund patient who is not expected to survive without the operation |
Examples include (but not limited to): ruptured abdominal/thoracic aneurysm, massive trauma, intracranial bleed with mass effect, ischemic bowel in the face of significant cardiac pathology or multiple organ/system dysfunction |
| ASA VI |
A declared brain-dead patient whose organs are being removed for donor purposes |
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*The addition of “E” denotes Emergency surgery: (An emergency is defined as existing when delay in treatment of the patient would lead to a significant increase in the threat to life or body part)
These definitions appear in each annual edition of the ASA Relative Value Guide®. There is no additional information that will help you further define these categories.
Download pdf of ASA Classification System
AGA Institute Review of Endoscopic Sedation
Cohen LB, DeLegge MH, Aisenberg JA et al. Gastroenterology 2007;133:675-701
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Class | Description |
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I |
The patient is normal and healthy |
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II |
The patient has mild systemic disease that does not limit their activities (eg, controlled hypertension or controlled diabetes without systemic sequelae) |
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III |
The patient has moderate or severe systemic disease, which does limit their activities (eg, stable angina or diabetes with systemic sequelae) |
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IV |
The patient has severe systemic disease that is a constant potential threat to life (eg, severe congestive heart failure, end-stage renal failure) |
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V |
The patient is morbid and is at substantial risk of death within 24 hours (with or without a procedure) |
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E |
Emergency status: in addition to indicating underlying ASA status (1–5), any patient undergoing an emergency procedure is indicated by the suffix ”E” |
ASGE Guideline
Sedation and anesthesia in GI endoscopy. Lichtenstein DR, Jagannath S, Baron TH, et al. ASGE STANDARDS OF PRACTICE COMMITTEE. Gastrointestinal Endoscopy 2008;68:815-826
ASA classification
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Class Description |
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IThe patient is normal and healthy. |
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IIThe patient has mild systemic disease that does not limit activities (eg, controlled hypertension or controlled diabetes without systemic sequelae). |
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IIIThe patient has moderate or severe systemic disease that does not [sic] limit the activities (eg, stable angina or diabetes with systemic sequelae). |
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IVThe patient has severe systemic disease that is a constant threat to life (eg, severe congestive heart failure, end-stage renal failure). |
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VThe patient is morbid and is at a substantial risk of death within 24 hours (with or without a procedure). |
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EEmergency status: in addition to indicating the underlying ASA status (1-5), any patient undergoing an emergency procedure is indicated by suffix “E.” |
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Quality Assurance Task Group of the National Colorectal Cancer Roundtable
Standardized Colonoscopy reporting and data system: report of the Quality Assurance Task Group of the National Colorectal Cancer Roundtable. Lieberman D, Nadel M, Smith RA, et al. Gastrointestinal Endoscopy 2007;65:757-766
ASA classification system (with Quality Assurance Task Force corollary definitions):
Class 1
Patient has no organic, physiologic, biochemical, or psychiatric disturbance (healthy,no comorbidity).
Class 2
Mild-to-moderate systemic disturbance caused either by the condition to be treated surgically or by other pathophysiologic processes (mild-to-moderate condition, well controlled with medical management; examples include diabetes, stable coronary artery disease, stable chronic pulmonary disease).
Class 3
Severe, systemic disturbance or disease from whatever cause, even though it may not be possible to define the degree of disability with finality (disease or illness that severely limits normal activity and may require hospitalization or nursing home care; examples include severe stroke, poorly controlled congestive heart failure, or renal failure).
Class 4
Severe systemic disorder that is already life threatening, not always correctable by the operation (examples include coma, acute myocardial infarction, respiratory failure requiring ventilatory support, renal failure requiring urgent dialysis, bacterial sepsis with hemodynamic instability).
Class 5
The moribund patient, who has little chance of survival.
Cleveland Clinic
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ASA PS Category
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Preoperative Health Status
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Comments, Examples
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*ASA PS classifications from the American Society of Anesthesiologists
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ASA PS 1
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Normal healthy patient
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No organic, physiologic, or psychiatric disturbance; excludes the very young and very old; healthy with good exercise tolerance
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ASA PS 2
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Patients with mild systemic disease
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No functional limitations; has a well-controlled disease of one body system; controlled hypertension or diabetes without systemic effects, cigarette smoking without chronic obstructive pulmonary disease (COPD); mild obesity, pregnancy
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ASA PS 3
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Patients with severe systemic disease
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Some functional limitation; has a controlled disease of more than one body system or one major system; no immediate danger of death; controlled congestive heart failure (CHF), stable angina, old heart attack, poorly controlled hypertension, morbid obesity, chronic renal failure; bronchospastic disease with intermittent symptoms
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ASA PS 4
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Patients with severe systemic disease that is a constant threat to life
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Has at least one severe disease that is poorly controlled or at end stage; possible risk of death; unstable angina, symptomatic COPD, symptomatic CHF, hepatorenal failure
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ASA PS 5
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Moribund patients who are not expected to survive without the operation
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Not expected to survive > 24 hours without surgery; imminent risk of death; multiorgan failure, sepsis syndrome with hemodynamic instability, hypothermia, poorly controlled coagulopathy
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ASA PS 6
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A declared brain-dead patient who organs are being removed for donor purposes
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Colorado Standards for Hospitals and Health Facilities
Standard defining admission criteria for ambulatory surgery centers (6 CCR 1011-1, last amended 01/19/11, effective 03/02/11)
The physicians performing the procedure shall document in writing that the patient is in good health or that any pre-existing health conditions are adequately controlled, require no special management and are such that performance of the procedure in an ASC, rather than a hospital setting, does not pose an increased risk to the patient.
Prior to 03/02/11 the language in this regulation was:
The patient must be in good health or have mild systemic disease which is under good control and does not require special management.
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